The author is a Forbes contributor. The opinions expressed are those of the writer.

Loading ...

Loading ...

This story appears in the {{article.article.magazine.pretty_date}} issue of {{article.article.magazine.pubName}}. Subscribe

As Obamacare moves into implementation, there are a couple of related areas of bipartisan agreement. First, this past week's Time Magazine's cover story (Bitter Pill: Why Medical Bills Are Killing Us) highlights that costs are the #1 issue yet to be adequately tackled. Second, a modern technology infrastructure is imperative to deliver better and more efficient healthcare.

Much still needs to be done but there have been a few signals from the Obama administration that it is moving on to improve healthcare quality while reducing costs. As a healthtech startup founder myself, I'm hardly objective, but I'm not alone in recognizing that the technology industry has had a dramatic impact on lower costs while improving quality in virtually every industry except healthcare. There are a few recent actions the federal government has taken to change that. Healthcare has been inhospitable to modern computing approaches in the past and that has resulted in subpar technology solutions that frequently cost 10x what they do in other industries. Noted industry analyst, Brian Klepper, PhD, highlighted the associated problems in An Archipelago of Health Information Islands.

The nation’s “healthIT czar” (Dr. Farzad Mostashari) runs an organization called the Office of the National Coordinator (ONC), originally setup by the Bush Administration. Later, the Obama Administration doubled down on efforts to catch healthcare up with the rest of society in terms of adoption of modern technology in electronic health records (EHRs). Even today, the “Wang era” (i.e., one vendor provides the entire technology stack) persists in healthcare. Like the Wang era, there is limited ability to interface with other systems. For even simple integrations, several thousand dollars is a normal vendor charge to enable integration that would be free or near-free in a modern web services architecture. To its credit, the ONC is trying to break healthcare out of its technology twilight zone and unleash innovation akin to the post-Web, post iOS/Android app store world.

While most entrepreneurs I know simply want the government to stay out of the way, we also appreciate when the government unleashes opportunities. By opening up weather and GPS data, the government contributed $100 billion to the economy when companies leveraged that data. Of course, the Internet itself started out as a government project. Until one argues to get rid of Medicare, the federal government should use its bullypulpit, buying power and rule-making ability to open up opportunities for new ventures, rather than favor incumbent players. As I asked in Mr. President: The Deficit Problem was Solved Last Week but for the Preservatives, will the President support the "transformers" or the "preservatives" (i.e., those just trying to protect the status quo)?

I'll highlight below a few things the government is doing to unleash technology innovation that can save money and lives. Note that "startups" can be new ventures within established enterprises though history would suggest that it's the exception, rather than the rule. Or, in the case of iTriage highlighted below, they were a startup that was acquired by a health insurance company (Aetna) that is trying to redefine themselves beyond being just an insurance company (a move others are likely to follow).

Federal Standards/Ruling Poised to Unleash Startup Innovation

The essence of what the ONC is trying to achieve is unleash startup ventures that gets enabled by the equivalent of standards such as HTTP that unleashed the web and led to 1000′s of web services. In 2012, the ONC rolled out the Automated Blue Button Initiative meant to open up health information that is technically owned by consumers, but has been painfully difficult to access. The Web ushered in a new era. Until recently, healthcare moved at such a glacial pace that it didn’t follow the pattern nearly every other industry followed. Zina Moukheiber wrote a piece recently with a headline that looks like it was written by The Onion — Government Should Slow Down Race to Implement Electronic Health Records. I can’t remember a time when a technology company complained about things moving too fast — particularly in light of the fact that healthcare decision processes have generally been extremely long.

Next week, there is the biggest healthIT conference of the year (HIMSS). Legacy vendors will breathlessly make announcements such as “investing $10 million in patient engagement” that include developing mobile apps that are the equivalent of the apps in the Verizon app store. We know how that turned out – depending on one vendor greatly limits innovation. In contrast, the ONC just made a ruling (details below) that is another big move to unleash innovation. While some of ONC’s moves can appear small at first, the market signaling effect can turn the snowball into an avalanche of new EHR-agnostic, carrier-independent apps akin to the iOS and Android app stores. Further, it goes beyond just technology to impacting business strategies. For example, John Lynn, a leading healthcare journalist, speculated on how the recent ruling could give health systems an alternative to the expensive practice of buying medical practices to buy loyalty. Since buying up practices has historically led to increased prices, payers (private and public) have a strong desire to not have all practices get gobbled up by large enterprises. Consequently, it's in the payers best interest to encourage the adoption of strategies such as this.

Jan Oldenburg (editor of the seminal book on patient engagement entitled Engage! Transforming Healthcare Through Digital Patient Engagement) tweeted ”This looks like the first ONC acknowledgment that patient (portal) experience needs to have community data”. [Disclosure: I had the honor of helping write and edit that book with Jan, Kate Christensen and Brad Tritle. There is also a track at HIMSS13 focused on Patient Experience where we'll highlight patient engagement successes and lessons learned.]

There is an ongoing effort by the ONC started in the Bush administration and continued today to break down the information silos that have plagued healthcare leading to patient safety issues and unnecessary waste. Recently, the ONC ruled that healthcare providers utilizing EHR-agnostic (i.e., systems not from the EHR vendor themselves), multi-provider patient portals can gain a major advantage over those using the old model of silo’ed EHR patient portals. In a nutshell, providers have to get a portion of their patients to actively use data.

I'll use a scenario to describe the benefit: A patient is discharged from the hospital and then goes to their independent primary care physician. That general internist refers her patient to a cardiologist. After seeing the cardiologist, the patient logs into a portal that’s shared by the internist and the cardiologist. The bonus for internist and hospital, then, is that she gets credit for that patient logging into the portal, even though the patient logged in after visiting the cardiologist portion of the patient portal, not the hospital or internist's. Had the cardiologist, hospital and internist not shared a portal, then obviously they'd get no credit for the patient logging into the cardiologist’s own portal after the patient visited the cardiologist.

As leading healthIT pundit, Leonard Kish, stated, “This is a big step forward in patient engagement that recognizes consumers prefer a tool that’s similar to Quicken or Mint in personal finances, a place where all their information can be brought into one place that’s portable, and if need be, shareable within a larger community. While diminishing patient options, the single entry to a portal also diminishes the ability of the hospital to build the relationships with a network of outside providers and patients who are so critical to improving care, and ultimately, bringing more patients to the hospital. The key for both patients and providers is building a community of shared information that can drive improved outcomes through group learning.”

Healthtech Entrepreneur Invited to the State of the Union

For the first time, a healthtech entrepreneur was invited into the First Lady's box at the State of the Union to reinforce the administration's commitment to supporting and highlighting innovative new approaches that it wants to unleash.

I asked Dr. Peter Hudson (Co-founder of iTriage) some questions about why he was invited into the First Lady's box for the State of the Union. iTriage is an example of the good news part of Great News: HealthIT is terrible and expensive.

Q: Pete, I understand you were in the First Lady's box at the 2013 State of the Union address. How did you come by that invitation?

A: I got a call a few days before the speech from the White House that we had received a personal invitation from First Lady Michelle Obama to attend the 2013 State of the Union as her guest, sitting in the Presidential viewing box. I was thrilled and surprised, but very excited to represent iTriage, the healthcare IT industry, and our millions of users at the event.

Q: Why do you think the President chose the healthtech industry over another to highlight?

A: iTriage is the first healthcare IT or consumer healthcare technology company to receive such an accolade, but healthcare overall is certainly on the President's agenda. We heard several remarks from him on the state of our industry, it's trajectory if we don't make changes, and our need to fix certain programs before we bankrupt them. We feel that engaging the consumer is the key to achieving this change.

Q: Expand on the President's State of the Union remarks on Medicare and the healthcare system overall.

A: As you've noted and the healthcare industry agrees, our system is broken. And current consumer behavior is only going to make things worse, as we continue to select inappropriate medical care based on our true needs. Something like 40 percent of all ER visits are unnecessary -- they can be addressed at an urgent care or even by a primary physician. In a lot of cases, and I can attest to this from my 20 years of ER experience, consumers can make better healthcare decisions with the right tools and information. I believe it will require tools that provide the information right when you need it. And mobile fits that model really well.

Q: And iTriage offers that decision support?

A: We do. We actually offer a few different tools within our platform for a wide variety of audiences, which is necessary considering how broad and complex healthcare needs are. iTriage is a free smartphone and web app that starts with a symptom checker, but then helps the user navigate through different pathways, from possible conditions to the treatments, providers, medications and procedures that may be related. Based on what the user is experiencing, iTriage helps the user connect with the level of care that would be appropriate, and then helps them navigate there. That person can also look at wait times at urgent care and emergency rooms they're considering. We also offer a pharmacy discount that ranges from 15 to 85 percent off the majority of prescriptions, and though it cannot be used in conjunction with an insurance plan, it can sometimes offer a better value.

Whether you think it’s a good or bad thing that government is involved in healthcare, there is no disputing that they are a major player. As one of the few areas of healthcare where there is bipartisan agreement, the ONC has widespread support. The only legitimate concerns I’ve heard raised is that the ONC is too timid, moving too slowly and setting targets for achieving “Meaningful Use” far too low. For example, the ruling mentioned above applies to a requirement to have 5% of patients view, download or transmit their health information. At the same time, some organizations are getting over 50% of their patients to take those steps and that is on a single, silo’ed patient portal — not one that covers all of their providers. In light of the fact that one has to be pretty “engaged” to go to the trouble of scheduling a doctor’s appointment and likely taking half their day, a a minimum goal should be 20%. Getting one out of five patients to take an action that they are pre-disposed to take in the majority of situations doesn’t seem like it’s tough.

I can empathize with the ONC as they are getting an earful to slow things down, but they also recognize that lives are literally at stake when things get slowed down. The ONC's role isn't too protect out-of-date, slow-to-move vendors. There is an old saw that the best way to kill a bad product is good advertising. Perhaps the new saw is the best way to kill a bad EHR is good Meaningful Use requirements.

I don’t know of anyone who lived a full life who has had only one doctor their entire life. This is especially true with the 50 million Americans moving every year and many more changing jobs (and thus health plans/providers). I took stock of my family of four who had a healthy 2012 and we still went to seven different providers and I don’t want seven user id/password combinations. We’ve also been on three different health plans in the last four years. The best patient portal in the world has limited value if you can’t take that information with you. That healthcare still applauds “patient centric” organizations that charge $1 per printed page of your health records when you leave their health plan/system speaks volumes. There would be congressional hearings if financial institutions prevented consumers from downloading their transactional history or they were charged $1 per printed page of their history yet the equivalent of that in healthcare has oddly become the norm.

Fortunately, it appears the ONC is going to rectify that in Stage 3 of Meaningful Use by having the default be that a patient can choose where their data is sent. One can only imagine the criticism the federal government would receive if after sending $28 billion of taxpayer money on encouraging EHR adoption that consumers were unable to get easily their own data (not to mention the $750 billion waste in healthcare). The fact that this is still a topic of discussion is stunning. Having spent time with the ONC leaders (see also Mr. Obama, Tear Down This Wall(ed Garden), I have 100% confidence in Dr. Mostashari’s leadership that his organization won’t be swayed by the silo-loving vendors holding on to the Wang era as long as possible. Anything less would be the missed opportunity of the century.

Follow me on Twitter @chasedave or LinkedIn (www.linkedin.com/in/chasedave) if you'd like updates on these topics.